| NPI | 1285780833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D7130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13168) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-05-13 |